Stress and Primary Headache: Review of the Research and Clinical Management

Abstract

This review begins with a discussion of the nature of stress and then presents the functional model of primary headache as a framework for conceptualizing the complex relationship between stress and headaches. Research is reviewed on stress as a trigger of headaches and how stress can play a role in the developmental and psychosocial context of headaches. Clinical management of headaches from a stress perspective is considered both at the level of trials of behavioral interventions that broadly fit into the stress management category and the additional strategies that might be useful for individual cases based on the research demonstrating associations between stress and headaches. The review concludes by suggesting that although some researchers have questioned whether stress can trigger headaches, overall, the literature is still supportive of such a link. Advances in methodology are discussed, the recent emphasis on protective factors is welcomed, and directions for future research suggested.

The Headache Triggers Sensitivity and Avoidance Questionnaire: Establishing the Psychometric Properties of the Questionnaire

“…It is not always possible, however, to avoid certain triggers (eg, hormonal fluctuations or the weather). The process of attempting to avoid all triggers can in itself also cause a person stress, which has been identified as the most common trigger for migraine and tension‐type headache (TTH), for both genders . There is also a consensus within a variety of psychological literatures which views avoidant coping strategies to be maladaptive, especially in relation to stress, chronic pain, and anxiety.…”

Psychological Treatment for Headache: A Pilot Study on the Efficacy of Joint Psychoeducational Group and Relaxation Training

“…The improvement was unrelated to headache sub-types. Noteworthy, stress triggers attacks both in migraine and tension-type headache [29], even though their different pathophysiology. So, we can hypothesize that the influence of our intervention is on the amelioration of the negative influence of stress in triggering headache attacks.…”

Non‐Pharmacological Treatment for Primary Headaches Prevention and Lifestyle Changes in a Low‐Income Community of Brazil: A Randomized Clinical Trial

“…3 Even in the public health system of developed metropolitan areas in Brazil, nearly 30% of patients do not receive any headache preventive treatment. [6][7][8] Promoting health behavior and lifestyle changes, including management of perceived stress through relaxation, [6][7][8][9][10][11] and increase physical activity levels through aerobic exercise, [12][13][14][15][16] has been shown to be effective to improve clinical outcomes in primary headache disorders. [6][7][8] Also, such approaches may promote health behavior such as increased physical activity, albeit studies have been limited to tertiary clinics settings.…”

“…[6][7][8] Also, such approaches may promote health behavior such as increased physical activity, albeit studies have been limited to tertiary clinics settings. [6][7][8] Promoting health behavior and lifestyle changes, including management of perceived stress through relaxation, [6][7][8][9][10][11] and increase physical activity levels through aerobic exercise, [12][13][14][15][16] has been shown to be effective to improve clinical outcomes in primary headache disorders.…”